Underemployment is one trend that has affected vulnerable populations, since lower-paying jobs and part-time jobs seldom offer health insurance benefits. This is an increasing number of people, a serious trend in today's economy, which improving unemployment statistics do not reflect. People who are underemployed thus have no health benefits at all, and their ability to pay outright for services is compromised, of course, by their low income.

Another trend that affects these populations is the movement in many of our state governments to cut back on Medicaid eligibility, which federal regulation permits. Some states have done so significantly, with various eligibility requirements added and a Draconian response of simply cutting off eligibility for those who have difficulty completing all the paperwork needed. People who must pay outright for medical care under these circumstances seldom have the wherewithal to do so.

Still another trend is the reluctance or outright refusal of physicians and other healthcare providers to take Medicaid or Medicare covered patients. For many vulnerable people, the poor and the elderly, for example, this means there is no access to healthcare at all, and if there is access, they cannot afford to pay for it.

In conjunction with all of the above, vulnerable populations resort to the emergency room for treatment quite often, which is the most expensive form of treatment there is. Those who do so have higher bills, have more severe problems because they have waited too long to get treatment, and of course, cannot afford to pay for the treatment they receive.

I have also read that hospitals and physicians charge uninsured people more for services than they do insured people, usually because managed care organizations bargain for set rates for services, something that individuals who have no insurance cannot do. This means, of course, that the uninsured must pay more for healhcare than those who are insured, so their ability to pay is problematic.